Dr. Donald W. Alves MD, MS, FACEP

Emergency Physician

About

Dr. Donald Alves practices Emergency Medicine in , MD. Dr. Alves assesses patients who seek immediate medical attention at any time of day or night. Emergency Medicine Physicians are trained to efficiently work with each patient and situation no matter how acute or life-threatening. Dr. Alves examines patients, determines means of testing, diagnoses conditions, and decides the best treatment methods.

Education and Training

Eastern Virginia Medical School

Eastern Virginia Medical School 1997

Board Certification

American Board of Emergency Medicine

Emergency MedicineAmerican Board of Emergency MedicineABEM

Provider Details

MaleEnglish 22 years of experience

Dr. Donald W. Alves MD, MS, FACEP

Dr. Donald W. Alves MD, MS, FACEP's Expert Contributions

Possibly. Some food allergies or sensitivities may induce a "rapid exit" phenomenon, e.g., diarrhea and abdominal discomfort while being eliminated ASAP. Food poisoning depends on the organism or toxin involved and often is identified earlier in the GI process, so presents with vomiting and abdominal discomfort -- seeking to eliminate the offending substance before it gets further along the GI tract. If it presents later, then can see the abdominal distress and diarrhea. If worried, consult your primary care provider or an Urgent Care Center.
Donald W. Alves, MD,MS,FACEP
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You need to speak frankly with the child's pediatrician. There can be multiple origins to the situational/stress reaction that culminates in what is referred to as a "panic attack." Dietary issues, social stressors (school/home/other), learning or psychological conditions, among other potential diagnoses--and as different as they sound, as are the interventions and treatments that can help manage and reduce their occurrence. For the short term, when one comes on, calming tones and reassuring brief phrases while attempting to limit external stimulation (bright light/noises/movement in the area, all of which are found in excess in an Emergency Department) can help the child gain a foothold to attempt to self-soothe/de-effervesce and regain their sense of control. Focus on slow and steady breathing. Eyes closed usually helps, and ear muffs (compact and comfortable - -not for the firing range, but to help reduce environmental noise).
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If you would like to be absolutely certain that your child catches something, by all means, take her to an ER. Otherwise, stop and ask these questions: 1) what have I done about it? Did you give age/weight appropriate dose of Children's Tylenol or Advil? You would be miserable with a temp of 102F as well. Try to fix that with simple intervention of medication. Next, is the child eating/drinking like usual or close to it? If no, do need to go to ER. If yes, keep reading. Is child -- once the fever down -- his or her usual self? If they are alert, engage with family, interact like usual, it is generally OK. If a child sleeps more when sick, it is because they are smarter than we are, and do not want to be awake to 'enjoy' every minute of the illness. Sleep facilitates recovery, as long as appropriate when awake. If lethargic, sleepy, poor feeder or won't eat or drink -- time to go to the ER. Last, fever is a matter of degree -- pun intended. If generally healthy, 102 is not that bad. 104 is not great. Either should be given a dose of medicine to lower the fever and see how it is going in about 1/2 hour. If child has medical issues, seizure disorder, asthma, etc., then you should discuss this in advance with your pediatrician.
Donald W. Alves, MD, MS, FACEP
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Are you sure it is a "duck?" While the ER should just about never be the place to go if you have other access options and are comfortable that your issue is a urinary tract infection (UTI) -- in your example, those are almost never accompanied by severe abdominal pain. So, I would suggest that you have severe abdominal pain, which only rarely can be properly evaluated in office or clinic settings and should go to the ER. Appendicitis; torsion; diverticulitis; gallbladder issues; early pregnancy issues; and multiple others can cause the symptom. While it is true that drinking water will not temporize the pain from the concerning potential actors above, relying on a coincidence can often delay presenting for evaluation and care. Get seen and feel better.
Donald W. Alves, MD, MS, FACEP
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In a word, YES. Household chemicals are not intended for human consumption, and modern cleaning agents have a much greater potential for harm than an old-fashioned bar of soap. You should speak with those under your care about the dangers of peer pressure, and the concept that it being "in print" or "on the Internet" does not have any bearing on factual accuracy or truth. Individual medical conditions, sensitivities, and prescribed medication use can all interact to make an individual more susceptible to a bad outcome, and, especially in the young, can result in a lifetime of difficulties and disability.
Cinnamon, Tide pods, bath salts - all have appropriate uses, and inappropriate suggestions for alternate intake, masquerading as a "challenge" or similar term, posted or reposted by persons not interested in your personal health or safety.
Donald W. Alves, MD,MS,FACEP
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That is a multi-faceted question, depending on how early and how definitively. Many persons who go on to have a stroke have warning symptoms in the hours to days prior--transient impairments (often called TIAs) that resolve after a few minutes. If these brief episodes of one-sided weakness / facial appearance change, or speech changes are mis-attributed by the patient to an unlikely medical cause, then they cannot aid the patient by getting them in to care earlier--and before the onset of a stroke.
As to once the blood vessel is blocked, symptoms come on immediately as the brain does not tolerate lack of blood flow to deliver its nutrients and oxygen. If, alternatively, the vessel leaks, those symptoms intensify over time, usually starting with an intense/sudden/severe headache, and symptoms can further develop or progress as the bleeding into the closed-space of the skull continues, depending upon where the event is taking place.
If in doubt, call 911. Time is brain.
Donald W. Alves, MD, MS, FACEP
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You should strongly consider calling 911 if someone "passes out" and there is any suspicion that something other than alcohol (alone) is the cause--other drugs, diabetes, trauma, infection, etc. If someone drinks enough alcohol to cause them to lose consciousness, it is concerning as they may still be absorbing alcohol from what they drank, which may increase their alcohol level even higher, and become a threat to their life. There is no method to "un-drunk a drunk" other than time. The wives' tale about coffee might make them a TINY bit more alert, but still very intoxicated, and not likely able to help care for themselves or move safely without fall risk, etc. Same goes for other stimulant drugs/energy drinks/etc. Best option is to place the person on his/her side, with lower arm extended upward and head resting on it, and legs spread to increase balance and stability of staying in that position. This can be done up against a piece of furniture or wall to provide extra support. That way, if they should vomit, it will drain out, and not cause them to choke.
Donald W. Alves, MD, MS, FACEP
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Severe allergic reactions often worsen in intensity and speed of progression with repeat exposure. Ideally, your son's EpiPen (or equivalent) should be readily available to where he is at all times, especially for outdoor activities. An age/weight appropriate dose of Benadryl should be kept with the pen (ask your prescriber to confirm the dose). As soon as sting identified to have occurred, with his history, give the Benadryl and administer the EpiPen, then call 911. If you know how, remove the stinger (for bees). Sit the patient in an easily accessible location for when EMS arrives, and attempt to keep him calm. Other than the Benadryl (and sip of drink to swallow it with), give nothing by mouth. If EMS is delayed, or symptoms progress despite the above, if the particular epinephrine autoinjector has a second dose, prepare the unit to administer it (usually twist-n-lock), and give second dose as advised by your prescriber.
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Adequate hydration is the primary prevention for heat illness. Other factors include access to adequate shade and other cooling factors (breeze, fan, ice, etc.), work or activity breaks to prevent over-exertion, and ideally a mechanism to unload accumulated heat burden over the day--cool shower, pool, misting station, etc. Review any medications for their impact on temperature control. Be particularly careful with the young, the old, the debilitated, and the obese. General benefit is also seen with sunscreens/hats or other protection for the skin directly.
Donald W. Alves, MD, MS, FACEP
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If the individual is alert enough to feel this way, they may safely sit by a fire or heater or under an electric blanket and self-monitor for getting too warm--they need external heat applied, after outer and wet items removed. If the person is confused, intoxicated, frail/elderly or otherwise should not be relied upon to control their own rewarming and heat exposure, then someone must remain with them constantly to avoid thermal injury (/burn) while trying to rewarm from cold exposure. If awake and alert, warm liquids (cocoa, tea, broth, etc.) can be given as well. If they are mentally altered, then EMS should be contacted while starting initial warming as possible.
Donald W. Alves, MD, MS, FACEP
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The most common reason people go to the ER relates to pain. Abdominal pain most often, but chest/back/muscle/joint -- with or without a history of injury or trauma -- to be evaluated and determined how to address. We see all comers for all reasons: orthopedic injuries, wounds, breathing difficulties, drug/alcohol use problems, social issues like abuse or loss of medical access to care, psychological issues. Whatever it is, we either treat it, or consult a specialist to address the issue.
Donald W. Alves, MD,MS,FACEP
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Third degree burns have destroyed the full-thickness of the skin, so unless very small in size, require skin grafting to heal properly. Grafting can be done by several specialties in medicine, but most often Plastic Surgeons. Second degree burns are partial-thickness, and their care ranges from supportive (topical agents to minimize scar, keep skin healthy, prevent or treat infection) to interventions like with full thickness, depending on if they are superficial-partial-thickness or deep-partial-thickness, their location on the body, and their size.
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Symptoms of staph infection vary by location (lungs, bladder, skin), but in general for skin infections with staph should expect to see redness, increased warmth, and usually tenderness of the area. Staph often is associated with abscess formation, so may see local area of swelling / bulging tissue, that may feel fluctuant (a bit like a water balloon). If the infection spreads, can develop fevers, chills, sweats. In general, should start off by seeing your Primary Care Provider or an Urgent Care for small or early skin infections. The Emergency Department only if see red marks moving up a limb from the original infection location ("streaking"), involves about 1/4 or more of the limb--much earlier if diabetic, elderly, immunocompromised, have indwelling hardware / grafts / shunts, or other complicated medical patients.
Donald W. Alves, MD, MS, FACEP
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The most important first step as a patient or concerned person nearby to someone who may be having a heart attack is to RECOGNIZE IT. About 2/3 of persons, males more than females, present in a pattern that could be considered "typical" or "classic"--this would be chest heaviness or uncomfortable pressure, often with radiation of the pain to the neck or arm (left more often than right), and often associated with an increased work of breathing, sweating, and nausea. The elderly, diabetics, and females more often have variants, some with little to no pain in the chest but with the radiating pain, some get acutely confused, some feel profoundly weak, and the difficulty breathing, sweating and nausea are usually present. Unfortunately, for 300-500K Americans per year, the first sign is cardiac arrest--so if concerned, better to call 911 and have an EMS professional start assessing you and transport you to an Emergency Department. You should NOT try to drive yourself to the Emergency Department if you think you are having a heart attack--this is the time to call 911. If your Primary Care Provider has counseled you to use aspirin for heart attack prevention, then you may consider taking four "baby" aspirin (4x81mg=324mg) or one regular strength aspirin (325mg)--but these should be chewed if taken--if uncertain, wait for EMS, as they may give it to you, or the Emergency Department will.
Donald W. Alves, MD, MS, FACEP
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Hyponatremia, or a significant drop in sodium level, is not a do-it-yourself repair. It is life-threatening, causing confusion, seizures, heart rhythm problems, and potentially death. The treatment depends on how quickly the sodium level dropped. Advanced age, kidney disease, infection of the urinary tract with certain bacteria, and some medications increase the risk of occurrence. A diet with liberalized (but not high) salt intake, and monitoring fluid intake to be certain that excess water is not ingested, can help reduce the risk of recurrence.
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Unfortunately, this is not enough information for a definitive answer. Fever does not usually go with peptic ulcer, unless it is eroding through and leaking into the abdomen, which then usually causes significant illness and/or discomfort, prompting an ER visit for care. If unrelated, the low-grade/intermittent fevers may be from an early viral process that is common this time of year - -the actual flu (influenza), or one of a few viral infections that cause either upper respiratory illness or GI tract illnesses. The flu and upper respiratory infections often last for a week. See your doctor or an Urgent Care if new symptoms or if worsening condition.
Donald W. Alves, MD, MS, FACEP
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